Commentary: BCSC diabetes program deserves expansion

Blue Cross Blue Shield of Texas, the state's largest health benefits provider, is launching a pilot program for chronic disease management. We hope that it is the start of a larger trend.

The program, called Bridges to Excellence, includes 50 physicians in 20 rural and metropolitan regions, including Dallas. It will reward physicians who identify patients with metabolic syndrome, defined as three of five conditions: unhealthy waistlines, high blood pressure, high triglycerides, low levels of healthy cholesterol and a diagnosis of diabetes or pre–diabetes. Combating these risk factors leads to improved diabetes control, primarily through healthier eating and exercise. Patient counseling will be an important component.

The approach seems obvious, but insurers and the government traditionally have reimbursed for tests and procedures rather than advising patients about healthier behavior. The promising program contains elements of pay–for–performance reimbursement, long advocated by reformers who want to reward physicians for tangible progress in patient outcomes.

Bridges to Excellence also recognizes that chronic–disease management requires – and deserves – special attention. Traditional primary care is designed to process patients with a variety of acute conditions, relying on diagnosing symptoms and performing tests. Chronic diseases require regular patient–provider interaction, emphasizing education and ongoing assessment to prevent complications and exacerbation of the condition.